Provider Demographics
NPI:1760639819
Name:TUFANO, CARISSA ANN (MSN)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:ANN
Last Name:TUFANO
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 WATERVILLE RD
Mailing Address - Street 2:HARVEST HEALTHCARE
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-2097
Mailing Address - Country:US
Mailing Address - Phone:860-678-9755
Mailing Address - Fax:860-284-6804
Practice Address - Street 1:21 WATERVILLE RD
Practice Address - Street 2:HARVEST HEALTHCARE
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-2097
Practice Address - Country:US
Practice Address - Phone:860-678-9755
Practice Address - Fax:860-284-6804
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT079510163WP0808X
CT003970363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT079510OtherRN LICENSE
CT003970OtherAPRN LICENSE